tbuckley/cabot-search huggingface dataset:
Abstract 11344: 30-Day Rate of Readmission and Economic Burden Among Patient With Spontaneous Coronary Artery Dissection
Authors: Ndausung Udongwo, Charles Ezeaka, Abbas Alshami, tochukwu egbujiobi, Anton Mararenko, Ann Kozlik, Mihir Odak, Richard Orji, Sarthak Aryal, Joseph Amoah, Jeff Selan, Michael Fatuyi
Journal: Circulation (2022)

Introduction: Spontaneous coronary artery dissection (SCAD) is a non-traumatic and non-iatrogenic separation of the coronary arterial wall and is an infrequent cause of acute myocardial infarction. SCAD most commonly affects women in their 40s and 50s, though it can occur at any age and can occur in men. Hypothesis: T here is limited data on readmission for SCAD. Therefore, we sought to determine the 30-Day Readmission rate (30-DRr) for SCAD &amp; its impact healthcare utilization in the United States. Methods: Using the 2017 &amp; 2018 National Readmission Database, a retrospective study of patient discharges with Spontaneous Coronary Artery dissection diagnosis according to ICD-10 codes. Readmission was defined as the first admission to any hospital for any non-trauma diagnosis within 30 days of the index discharged alive. The primary outcome was 30 DRr, while secondary outcomes were readmission mortality rate, most common diagnoses for readmission, &amp; resource utilization defined by total patient charge (TPC), &amp; hospital cost (THC). Results: A total of 479 index hospitalization for SCAD; mean age of 54.4years (SD±14.6), female 74.8%, with an in-hospital mortality rate for index admission of 4.4% (21). 30-DRr was 7.7% (35). The mean age for readmitted patient was 53.8yrs (SD±17.8), female 73.3%, with an in-hospital mortality rate was 5.7% (n=2), which was not statistically significant compared to index mortality. The total in-hospital cost associated with readmission was $ 320,401 &amp; TPC of $ 1,320,662. Conclusions: We observed 1 in 13 are readmitted within 30 days among patient with SCAD . SCAD patients are a vulnerable subset requiring additional outpatient care. Improved clinical care and management of SCAD with guideline-based therapeutics may help reduce readmission, mortality &amp; cost.
Abstract 11803: Applicability of the New Proposed Criteria for Iron Deficiency in Japanese Patients With Heart Failure
Authors: Atsushi Tada, Toshiyuki Nagai, Taro Koya, Motoki Nakao, Suguru Ishizaka, Yoshifumi Mizuguchi, Hiroyuki Aoyagi, Shogo Imagawa, Yusuke Tokuda, Masashige Takahashi, Yoshiya Kato, Masaharu Machida, Kenichi Matsutani, Takahiko Saito, Toshihisa Anzai
Journal: Circulation (2022)

Backgrounds: Iron deficiency (ID) is a common comorbidity in patients with heart failure (HF). A recent study from a large single-center chronic HF cohort including predominantly white British population showed that ID defined by current guideline criteria was not associated with poor outcome, and a new ID criteria targeting for HF population was proposed. However, its external applicability is unclear. Methods: We prospectively examined consecutive 711 chronic HF patients and measured serum iron, transferrin saturation (TSAT) and serum ferritin from a Japanese multicenter registry. The proposed ID criteria were TSAT &lt;20% and serum iron ≤13 mmol/L and the guideline ID criteria were serum ferritin &lt;100 ng/mL or, when ferritin was 100-299 ng/mL, TSAT &lt;20%. The primary outcome was all-cause death. Results: Of studied patients (433 male, mean age 71 ± 13 years, mean left ventricular ejection fraction 47 ± 16%), 198 (28%) and 416 (59%) met the proposed and guideline ID criteria, respectively. During a median follow-up period of 441 (IQR 306-564) days, the primary outcome occurred in 50 patients. There was no significant difference on primary outcome between the patients with and without guideline ID criteria ( P = 0.24) ( Figure A ), while patients with serum iron ≤10 mmol/L showed a higher mortality than those without ( P = 0.004) ( Figure B ). In multivariable Cox regressions, the proposed ID criteria, but not guideline ID criteria, were independently associated with higher mortality (HR 1.92, 95% CI 1.06-3.47; and HR 1.42; 95% CI 0.79-1.24, respectively) adjusted for significant covariates including age, hemoglobin, estimated glomerular filtration rate and log NT-proBNP, and the Meta-Analysis Global Group in Chronic Heart Failure risk score. Conclusions: As defined by the proposed criteria, but not the guideline criteria, ID was associated with higher mortality in patients with chronic HF, suggesting that the proposed ID criteria might be applicable to Japanese population.
Abstract 12300: Circulating Gut-Microbiota-Related Metabolite Phenylacetylglutamine Levels, Diet Quality, and Risk of Incident Coronary Heart Disease Among Women
Authors: Yoriko Heianza, Xuan Wang, Saumya Tiwari, Jeramie Watrous, Kathryn M Rexrode, Qi Sun, Mohit Jain, Joann E Manson, Lu Qi
Journal: Circulation (2022)

Introduction: Phenylacetylglutamine (PAGln) has been recently discovered as a gut-microbiota-related metabolite, and circulating PAGln may be related to risks of cardiometabolic abnormalities. Gut microbiota-related dietary intakes and high-protein foods may affect circulating PAGln levels. Hypothesis: We assessed whether circulating PAGln levels may be related to intakes of gut-microbiota-related food intakes, and higher levels of PAGln may be associated with greater degrees of cardiometabolic abnormalities. We also tested a hypothesis that higher levels of circulating PAGln may be related to higher risk of the incident coronary heart disease (CHD). Methods: Circulating levels of PAGln, diet assessed using 7-day dietary records, and cardiometabolic abnormalities were assessed in the Women's Lifestyle Validation Study (WLVS) (n=723). The associations between plasma PAGln levels and risk of incident CHD were analyzed in a prospective nested case-control of 1520 women (760 incident cases of fatal CHD and nonfatal myocardial infarction and 760 controls) from the Nurses’ Health Study (NHS). We identified incident cases of CHD over 10-14 years of follow-up time. Results: Higher levels of PAGln were associated with higher levels of circulating insulin, triglycerides, as well as lower levels of HDL cholesterol. We found that greater intakes of red meat and processed meat (p=0.01), but not of poultry or fish (p &gt;0.05), and lower intakes of vegetables (p=0.03) were significant factors associated with higher levels of circulating PAGln. In the prospective nested case-control study setting, higher levels of PAGln were associated with higher risk of the incident CHD. Every 1 unit increment of log-transformed PAGln was associated with a relative risk of 1.21 (95% CI: 1.01, 1.45) for the incident CHD. Conclusions: Gut-microbiota-affecting diet quality were related to circulating levels of PAGln. Circulating PAGln levels may be associated with cardiometabolic abnormalities and risk of incident CHD among women.
Abstract 11577: Disparities in One-Year Mortality Among Infants With Cyanotic Congenital Heart Disease - Insights From Contemporary National Data
Authors: Martina A Steurer, Charles McCulloch, Stephanie Santana, james Collins, Tonia Branche, Laura Jelliffe-Pawlowski, Shabnam Peyvandi
Journal: Circulation (2022)

Introduction: Racial inequities in congenital heart disease (CHD) are well documented. We examined the interplay between race, socioeconomic status (SES), and neonatal variables (prematurity and small for gestational age (SGA)) on 1-year mortality in infants with CHD. Hypothesis: SES and neonatal variables explain a significant part of observed racial disparities. Methods: Linked birth/death files from the Natality database for all liveborn neonates in the US were examined from 2014-2018. Infants with cyanotic CHD were identified. Non-Hispanic Black (NHB) infants were compared to non-Hispanic White (NHW) infants. The primary outcome was 1-year mortality. A composite measure of SES was created based on maternal education and insurance with a maximal level of 4 and a minimal level of 0 (least privileged). Other mediators included prematurity and SGA. A directed acyclic graph (Figure 1) was created a priori as a conceptual model. Additive structural equation modelling with bootstrapped confidence intervals was used to calculate the contribution of each pathway in Figure 1 to the primary outcome and percent mediated by SES, prematurity and SGA. Results: We identified 7,432 NHW and 1,452 NHB infants with cyanotic CHD. NHB race was associated with increased 1-year mortality (OR 1.40, 95% CI: 1.23-1.59) compared to NHW. Figure 1 shows the contribution of each pathway to one-year mortality. The effect of SES explained 35.9% (CI 22.0-67.3) of the mortality disparity between NHB and NHW race. The effect of SGA explained 16.5% (CI 8.8-30.2) and prematurity explained 12.0% (CI 5.4-26.1). The direct effect of NHB race was not significant (35.5%, CI -4.9 - 56.7). Conclusions: Less privileged SES and greater prematurity and SGA likely explain the 1-year mortality disparity in Black infants with cyanotic CHD. These findings identify targets for social intervention to decrease racial disparities in CHD outcomes.
Abstract 11627: Genetic Testing for Hereditary Amyloid Transthyretin Amyloidosis: Insights From the Compass Program
Authors: Kunal Bhatt, Diego H Delgado, Sami Khella, Meghan C Towne, Gwendolyn E Kaeser, Victoria Sanjurjo, Keyur B Shah
Journal: Circulation (2022)

Introduction: Hereditary amyloid transthyretin (hATTR, or ATTRv [variant]) amyloidosis is a progressive and fatal disease caused by alterations in the transthyretin ( TTR ) gene that result in the deposition of misfolded protein throughout the body, leading to multisystem dysfunction. The p.V142I and p.T80A pathogenic alterations typically manifest with a cardiac phenotype, and early diagnosis is crucial to achieving optimal patient outcomes. The hATTR Compass Program offers confidential genetic testing to patients suspected of having hATTR in the United States, Canada, and Puerto Rico. Methods: Patients were referred to Compass for genetic testing using a TTR single-gene analysis, a cardiovascular-focused 92-gene panel, or a neuropathy-focused 81-gene panel. All patient demographics were self-reported. This report analyzes patients with TTR alterations. Results: A total of 22,801 patients were referred for genetic testing; 1469 (6%) patients were positive for TTR . Of those, 1237 (84%) had the p.V142I alteration and 73 (5%) had the p.T80A alteration. Patients with p.V142I were predominantly Black (81%), while patients with p.T80A were predominantly White (86%). Most p.V142I patients were male (60%), while 48% of p.T80A patients were male. The average age at testing was earlier in patients with p.T80A (56 y) compared with p.V142I (67 y). The majority of p.T80A patients reported a family history of ATTR (64%), contrasting with only 23% of p.V142I patients. In patients with p.V142I and p.T80A who reported symptoms (1049 vs 42, respectively), most reported heart disease (90% vs 71%). Other symptoms included bilateral carpel tunnel syndrome (24% vs 31%), renal issues (22% vs 12%), and gastrointestinal issues (9% vs 31%). Patients with p.T80A reported a higher incidence of sensory (52%), motor (31%), and autonomic (29%) dysfunction compared with patients with p.V142I (31%, 18%, and 21%, respectively). Conclusions: Patients with p.V142I were mostly Black and were less likely to have a known family history of hATTR. Both p.V142I and p.T80A patients presented with mixed symptoms, including heart disease and polyneuropathies. Genetic testing may be an efficient path toward early diagnosis and treatment for this progressive and fatal disease.
Abstract 11201: Relationship Between Periodontitis and Atrial Fibrosis in Atrial Fibrillation: Histological Evaluation of Left Atrial Appendages
Authors: Shunsuke Miyauchi, takehito tokuyama, Yousaku Okubo, sho okamura, Shogo Miyamoto, Naoto Oguri, Taiichi Takasaki, Keijiro Katayama, Shinya Takahashi, Yukiko Nakano
Journal: Circulation (2022)

Introduction: Atrial fibrosis contributes to the onset and persistence of atrial fibrillation (AF) and AF-related stroke. Periodontitis, a common infectious and inflammatory disease, aggravates some systemic diseases. However, the association of periodontitis with AF and with atrial fibrosis has remained unclarified. Hypothesis: We hypothesized that periodontitis aggravates atrial fibrosis and conducted a histological study using resected left atrial appendages (LAAs). Methods: Seventy-six patients with AF (55 with nonparoxysmal AF, 25 with mitral valve regurgitation [MR], 18 with LAA thrombus) who were scheduled to undergo LAA excision during cardiac surgery were prospectively enrolled. All patients underwent an oral examination, and remaining number of teeth, bleeding on probing (BOP), periodontal probing depth (PPD), and periodontal inflamed surface area (PISA) were evaluated as parameters of periodontitis. The degree of fibrosis in each LAA was quantified by Azan-Mallory staining. Results: BOP ( R = 0.48, P &lt; 0.0001), PPD of &gt; 4 mm ( R = 0.26, P = 0.02), and PISA ( R = 0.46, P &lt; 0.0001) were positively correlated with atrial fibrosis. Among patients with &gt;10 remaining teeth, PISA was positively and strongly correlated with atrial fibrosis ( R = 0.57, P &lt; 0.0001; Figure). After adjustments for age, AF duration, BMI, MR, and CHADS 2 (congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack) score, PISA was significantly associated with atrial fibrosis ( β = 0.016, P = 0.0002). Conclusions: We histologically revealed the association of periodontitis with atrial fibrosis. This indicates that periodontitis, which is modifiable, is a risk factor for AF.
Abstract 12050: Ketone Ester Supplementation Reduces Cardiac Inflammation and Enhances Cardiac Energetics in Acute Myocardial Infarction
Authors: Salva Yurista, Aidan Welsh, William Jiang, Robert Eder, Shi Chen, Anna Foster, Jaume Coll-Font, Anthony Rosenzweig, Christopher T Nguyen
Journal: Circulation (2022)

Introduction: Myocardial infarction (MI) is a major risk factor for the development of heart failure with reduce ejection fraction (HFrEF). While previous studies have focused on HFrEF, the role of ketone bodies in MI is unclear. Hypothesis: K etone may exert some cardioprotective effects following MI. Methods: Male Yorkshire pigs underwent percutaneous balloon occlusion of the LAD for 80 minutes followed by 72 hours reperfusion period. Oral ketone ester (BHB-butanediol monoester, KE, 550 mg/kg) or vehicle was administered during reperfusion and continued during the follow-up period. Simultaneous blood sampling from coronary sinus and artery was obtained to quantify the extraction fraction of major cardiac substrates. Scar size was measured by LGE CMR and molecular markers were assessed in the LV. The study was approved by the IACUC at the Massachusetts General Hospital. Results: KE induced ketosis within 30 min after ingestion. KE increased β-hydroxybutyrate (βOHB) extraction in healthy swine without affecting glucose and fatty acid (FA) consumption. Despite similar infarct size in both MI and MI-KE groups, cardiac expression of proinflammatory cytokines TNF-⍺, IL-1, IL-6, and cardiac injury TTNI3 alongside with plasma hs-cTnI were reduced by KE. The untreated MI hearts consumed less FA with no changes in glucose uptake, whereas hearts from KE-treated animals consumed more βOHB and FA. KE increased cardiac expression of genes involved in ketone utilization MCT1 and SCOT after MI (p&lt;0.05 for all), indicating that cardiac uptake and utilization of βOHB as fuel were augmented. Together these metabolic changes were associated with an increase in cardiac ATP production. RNA-seq analysis identified differentially expressed genes related to mitochondrial energy metabolism. Conclusions: Oral KE induced ketosis and enhanced cardiac βOHB extraction in both healthy and infarcted hearts. Although infarct size was unchanged 72h after MI, acute oral supplementation with KE supressed cardiac inflammation and injury, altered cardiac substrate uptake and enhanced cardiac energetics following acute MI. Evaluating the potential chronic benefits of these changes on long-term remodeling after MI will be an exciting direction for future studies.
Abstract 12429: Grade Of CRS is Associated With Cardiac Dysfunction in the Acute Phase, but Do Not Predict the Prognosis of Diffuse Large B Cell Lymphoma Patients Who Underwent CAR-T Therapy
Authors: Isamu Sunayama, Kyung-Duk Min, Yoshiyuki Orihara, Satoshi Yoshihara, Kyoko Yoshihara, Masahiro Teramoto, Yuki Matsumoto, Makiko Oboshi, Koichi Nishimura, Yoshiro Naito, Hiroya Tamaki, Satoshi Higasa, Masanori Asakura, Masaharu Ishihara
Journal: Circulation (2022)

Introduction: As Chimeric Antigen Receptor T cell (CAR-T) therapy gains advantage in the management of diffuse large B cell lymphoma (DLBCL), accumulating evidence shows that it frequently accompanies cardiac dysfunction. Previous retrospective studies indicated the potential involvement of cytokine release syndrome (CRS) in cardiac dysfunction after CAR-T therapy, but no prospective study has reported the time course of cardiac dysfunction and its association with prognosis. Purpose: To prospectively examine the sequential changes in cardiac markers over time after CAR-T therapy and to clarify their association between the grade of CRS, cardiac markers, and prognosis. Methods: In this prospective study, 30 DLBCL patients who underwent CAR-T therapy were enrolled. Before and after the treatment, the level of cardiac biomarkers and echocardiographic index were sequentially collected. We classified all patients into two groups according to the severity of CRS after CAR-T therapy, namely Low-CRS group (CRS&lt;2) and High-CRS group (CRS≧2). Cardiac biomarkers, echocardiographic index, and long-term survival prognosis were further analyzed in both groups. Results: The average age of participants was 59.6 years, and 9 (30%) were female. The number of patients in Low- and High-CRS group was 13 and 17, respectively. At the baseline before CAR-T therapy, there were no significant differences in cardiac parameters between two groups. In High-CRS group, NT-proBNP levels were significantly increased on day 3 and 7 compared to the baseline and were significantly higher than Low-CRS group at both timepoints, whereas troponin T level did not show any differences. Likewise, in High-CRS group, GLS was significantly decreased on day 7 and 14 compared to the baseline and recovered toward baseline on day 28. GLS and EF did not show significant differences between Low- and High-CRS groups throughout the follow-up. The Kaplan-Meier analysis demonstrated that there was no significant difference in long-term survival prognosis according to the severity of CRS. Conclusion: This study revealed that CAR-T therapy induced transient changes in NT-proBNP level and GLS especially in High-CRS group in the first 2 weeks, but they did not predict the long-term prognosis.
Abstract 11909: Education of Children Improves Awareness of Hypertension Novel Method to Improve Health Equity
Authors: Margaret K Wallace, Amy C Ladd, David Innes, Kimberly McKnight, Kristine C Olson, Unice Davis, Krishna Ravindra, Namita Raghavan, Carrie R Mills, Ralph Dagostino, William G Hundley, Phillip Duncan, Sangeeta B Shah
Journal: Circulation (2022)

Introduction: Approximately 45% of the U.S. population has hypertension (HTN), with increased prevalence in Black adults in urban areas. HTN is a risk factor for heart disease, stroke, and renal failure. Increasing awareness of HTN during early education may improve health equity. We hypothesized a blood pressure (BP) educational program administered to primary school children would increase their awareness and knowledge of HTN. Methods: We engaged 31 4 th &amp; 5 th graders from a predominantly Black, urban school in an innovative, experiential educational program administered across four, one-hour sessions as part of their curriculum. We taught and assessed students’ awareness of HTN across four topics: (1) knowledge of BP &amp; HTN, (2) organ systems impacted by HTN, (3) habits to maintain a healthy BP, and (4) their competence to operate a BP monitor according to AHA recommendations. Using a 24-question survey, assessments of the first three categories were completed pre-program (baseline [BL]), one-day &amp; 42-days (6 weeks) post-program. Results: Students’ knowledge of BP &amp; the AHA HTN definition and organ systems impacted by HTN was low pre-program, but significantly improved at one- &amp; 42-days post-program. Students’ knowledge of habits to maintain healthy BP was high at BL and did not change throughout the program (Table). Forty-two days post-program most students were able to perform BP measurements per AHA guidelines (&gt;57.7%) and were able to correctly identify systole and diastole measurements (&gt;69.2%). Conclusion: Implementing an educational program focused on knowledge and measurement of BP and HTN in 4 th &amp; 5 th grade classrooms significantly raised awareness of HTN immediately and at 42-days post-instruction. The students retained the ability to measure BP and understand the components of BP. Raising awareness of BP and HTN in urban early education settings is feasible and may be the first step to decreasing the morbidity of a highly prevalent and modifiable disease.
Abstract 12067: The Impact of the COVID-19 Pandemic on Congenital Heart Defect-Related Healthcare by Age and Insurance Status
Authors: Sherry L Farr, CHARLES ROSE, Karrie F Downing, Michael Fundora, Matthew E Oster
Journal: Circulation (2022)

Objective: To examine congenital heart defect (CHD)-related healthcare for children and adults during the COVID-19 pandemic. Methods: IBM Marketscan® Commercial and Multi-State Medicaid Databases from 2018-2020 were used to examine outpatient and inpatient encounters and cardiac procedures/surgeries with ≥ 1 CHD ICD-10-CM codes (Q20-Q26; Z87.74), excluding isolated Q21.1 and encounters with a COVID-19 ICD-10-CM code. Monthly rates of encounter types per 5 mil enrolled children and 15 mil enrolled adults and percent telemedicine encounters were averaged across 2018-2019 and compared to 2020 by age (0-17y and 18-64y) using chi square tests. Results: Data included 583,069 commercial (private) and 796,579 Medicaid CHD-related encounters in 2018-2020. For all groups, rates of encounters were lowest in Mar-May 2020 (Fig). In Jun-Dec 2020, rates returned approximately to 2018-19 levels, but were lower than needed to offset fewer encounters in the spring. Per 5 mil enrolled children in private and public insurance, there were over 8,400 fewer CHD-related outpatient encounters, 5,300 fewer inpatient encounters, and 260 fewer cardiac procedures/surgeries in 2020 compared to 2018-19 (p&lt;0.0001). In Jan-Feb 2020, adult Medicaid outpatient encounters were above 2018-19 levels. However, per 15 mil enrolled privately- and publicly-insured adults, there were over 5,600 fewer inpatient encounters and 460 fewer cardiac procedures/surgeries in 2020 compared to 2018-19. Telemedicine encounters were highest in Apr 2020 and remained above 2018-19 levels through Dec 2020, with the highest percentage among privately-insured adults (p&lt;0.0001). Conclusion: In the second half of 2020, CHD-related encounters returned to 2018-19 levels, yet did not compensate for lower-than-expected encounters in the spring, resulting in fewer pediatric CHD-related encounters and fewer adult CHD-related inpatient encounters in 2020. Use of telemedicine differed by insurance and age.